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A mixed method study to describe the factors associated with palliative care inequalities experienced by heart failure patients in the North West, and the impact of these inequalities

   Lancaster Medical School

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  Dr Amy Gadoud, Dr Maddy French, Dr S Brearley  No more applications being accepted  Competition Funded PhD Project (UK Students Only)

About the Project

Aim of PhD

This exciting funded PhD project is supervised by palliative care academics with expertise in mixed methods, routinely collected health data and extensive PhD supervision experience. The project is based in the Faculty of Health and Medicine, which hosts the  International Observatory on End of Life Care (IOELC) | Lancaster University.

The student will explore factors associated with inequalities in recognising the need for palliative care in the community and how these inequalities can be overcome. This is a novel PhD which will develop expertise in conducting high quality methods and in health inequalities. The student will join a North West Cancer Research funded studentship working in the area using similar methods exploring inequalities for cancer patients.

Proposed outcomes

We expect two main outcomes from the study. The first is a measure of the extent to which patients’ social, economic, and other characteristics (e.g. age, gender, social deprivation) impact on palliative care outcomes (recognition of palliative care need, hospital admission, dying in hospital). This will provide an understanding of the extent to which inequalities in these outcomes exist in a costal area in the North West

Second, the a set of factors, or theoretical model, will be developed which explains why inequalities in recognising palliative care needs exist in community settings.


Early palliative care in heart failure consistently leads to better patient and caregiver outcomes but often the need for palliative care is not recognised. Socioeconomic and other factors are known to have an impact on accessing palliative care services and place of death, but these factors have mostly been investigated regarding access to specialist palliative care services or data using hospital records. The global pandemic and the recent report from the Chief Medical Officer, Professor Whitty regarding coastal communities have highlighted the urgent need to tackle health inequalities This project will use a unique large dataset of primary care and linked secondary care data.

What the student will do?

The student will conduct a mixed method study with three concurrent phases and a final consensus and prioritisation of recommendations phase.   

Phase 1 is a systematic literature review to identify factors associated with inequalities in identifying a need for palliative care in heart failure patients.  

Phase 2 is a cross sectional analysis of contemporaneously collected GP and linked hospital records of heart failure decedents (2018-2020) in a North West area to determine the impact of patient characteristics (e.g. age, gender, social deprivation) on outcomes relevant to palliative care (such as lack of recognition of palliative care, death in hospital and hospital admissions in the last year of life).

Phase 3 uses indepth interviews with General Practitioners (GPs) in the North West to explore perceived factors associated with inequalities in recognising when a palliative care approach is needed.

Phase 4 utilises the results from phases 1-3 with a panel of key stakeholders to identify and develop recommendations about how the factors associated with inequalities for people with heart failure can be overcome.

Training available

As well as the fortnightly supervision, training is provided across all stages of the programme, with emphasis placed on the elements of particular relevance to this PhD (including research ethics, systematic literature reviews, secondary data analysis, qualitative data collection and analysis etc). Alongside the training offered as part of the Division of Health Research PhD programme, additional quantitative data analysis training and support can be accessed through Lancaster Medical School’s postgraduate courses and from the Maths and Stats Hub (MASH) at Lancaster University.

PhD students within the Faculty of Health and Medicine are encouraged to access a range of interdisciplinary research training from across the university, and to engage with the Lancaster University Doctoral Academy (https://www.lancaster.ac.uk/research/doctoral-academy/). 

Application process: Applications should be made in writing to the lead supervisor, Dr Amy Gadoud ([Email Address Removed]). You MUST include the following

1.     CV (max 2 A4 sides), including details of two academic references

2.     A cover letter outlining your qualifications and interest in the studentship (max 2 A4 sides)

Funding Notes

The full-time studentships are tenable up to 3 years full-time (subject to satisfactory progress) and will cover the cost of tuition fees at Home/EU rates alongside a stipend in line with the UK Research Council is payable.
It is expected the successful applicant will commence 1st October 2022.

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